[Acute leukemias in adulthood--cure in sight?]

Better results have been achieved in the treatment of acute leukemia of adults by adaptation of therapeutic strategy to increased knowledge and to subtle differentiation of the various forms of the disease. The higher the resistance of leukemic blasts to chemotherapy, the more aggressive the induction therapy necessary to achieve favourable results. Intensive therapy produces a transient phase of bone marrow aplasia in which the patients must be protected by supportive care. Sensitivity to chemotherapy is relatively low in acute myelocytic leukemia. Therefore, the maximum tolerable dose of multi-drug chemotherapy is necessary to induce complete remissions (CR), which can be achieved in about 75% of patients under 65 years. Up to 40% remain in continuous remission longer than 3 years. The recurrence rate is high. Relapses are highly resistant to therapy, and therefore bone marrow transplantation is considered during the first CR. Most cases with acute lymphocytic leukemia are associated with higher sensitivity to chemotherapy. Less aggressive induction therapy in combination with maintenance therapy achieves CR in up to 85% of patients, about half of whom remain in continuous remission more than 3 years. Most of these cases can be regarded as cured.